1. Field of the Invention
The present invention relates to systems and methods for optimizing behavioral health care data collection, and, more particularly, for customizing an instrument for determining a patient's behavioral health condition.
2. Description of Related Art
Health information systems in general, and behavioral health information systems in particular, have been the subject of considerable development efforts. Increasing demands have been placed by regulatory agencies and "hosts," which comprise the insurance companies, health-maintenance organizations, or hospitals that typically approve and pay for a care regimen for a patient. Extensive record-keeping is required, as well as extensive forms generation, time-intensive but non-revenue-generating activities.
Behavioral health care systems share some characteristics with other types of health care systems, including the need for data handling and transfer and billing functions. However, the results achieved with knowledge gleaned from the behavioral sciences until recently have been resistant to quantification and have endured the label of being "soft." For example, it is relatively simple to deduce that a patient can in most cases be cured of a particular type of infection with a dosage of an antibiotic administered over a period of time. However, similar deductions are more difficult to achieve with a behavioral health problem: How many sessions will it take to "cure" a depressed person? What does "cure" actually mean? Therefore, it would be desirable to be able to rate a severity of a behavioral health problem and to track the patient's improvement over time, including all the variables that comprise the treatment (type and duration of therapy, medication).
In a currently typical provider environment, such as a clinic, several therapists may treat patients on an outpatient basis. On a first visit the patient spends time filling out an information sheet, including demographic (i.e., social security number, name, and address) and insurance information. This handwritten information is then transcribed by a clinic employee and entered into a locally maintained database. Following a patient session, a form is generated, either manually or via the computer, and mailed or faxed to the host. The form contains one or more billing codes, such as those contained in the CPT Code Table, a widely used standard.
At the host site, the data on the form are correlated with a host database to ensure that the patient has a current policy and that the service provided is covered by that policy. This is usually undertaken by a case manager or claims adjudicator, who then either approves or disapproves the service for payment to the provider.
In the behavioral health field, a therapist typically diagnoses a patient's behavior(s) (e.g., absenteeism, acting out) and problem(s) (e.g., anxiety, depression) using the criteria set forth in the Diagnostic and Statistical Manual of Mental Disorders (DSM) and makes detailed handwritten chart notes expanding upon the patient's status. The DSM codes are relayed to the host, accompanied by the CPT code(s), with a request for payment and/or request for treatment approval.
Should the service recommended or provided fall outside the bounds of the patient's coverage, for example, if the patient has not improved sufficiently after a prescribed series of sessions, the provider will have to request additional sessions. Such a request may occur, for example, by sending case notes to the host, which again will have to be reviewed by a case manager.
Another area in which information systems have been applied is in treatment outcome evaluation, wherein a test or a series of tests is repeated at specified time intervals in order to monitor a patient's progress during therapy.
Yet another area of usefulness for information systems is in the establishment of a sufficiently large database to enable the calculation of average treatment outcomes. Such an evaluation is intended to provide an indication of treatment norms for a range of behavioral problems and severities. This will enable a host and/or provider to assess the relative effectiveness of a particular patient's treatment over time as compared with the norm. Such data would also be effective in aggregating results for a particular provider site (e.g., clinic) or therapist.
A health resource consumption system has been described by Mohlenbrock et al. (U.S. Pat. No. 5,018,067); an apparatus for measuring psychotherapy outcomes, by Brill (U.S. Pat. No. 5,435,324; and a microcomputer-based mental health information system, by McCullough et al. (American Psychologist 41, 207-14, 1986).
There is no known system that integrates and automates all the behavioral health care provider functions, including maintaining patient records, monitoring patient progress, performing scheduling operations, preparing billing and clinical reports, sending and receiving patient information directly online with a host system, and interfacing with an external database for amassing behavioral health care statistics. Further, there is no known interrelated host system that links multiple provider sites for managing clinical and financial data and permits automated case management, data aggregation, a treatment plan formulary, a query tool, and executive reporting capabilities.